Harm Reduction Guide to Coming Off Psychiatric Drugs

This is a wonderfully clear and balanced account of the issues around psychiatric medication and in particular, coming off it. But it is also much more than that, covering such thorny questions as the nature of psychiatric problems, the contributions of environment and heredity, the validity of diagnosis, and many others. It is written in layman’s language, but would be useful for anyone involved in the use or prescription of medication.

The watchwords are that everyone is different; that psychiatric medication can be beneficial to some people at some times; but that anyone can potentially come off it, though that should be done slowly, with careful monitoring. It points out many disadvantages to the use and overuse of medication. But it also has a great deal of straightforward information on how medication can be helpful.

The approach in this guide is fully in line with the principles of recovery. People should be empowered to choose for themselves what is the best approach for them. As regards medication, they need full information on the effects and side effects, and shared decision making along with mental health practitioners as appropriate.

The emphasis throughout is on reducing the harm from mental ill-health and from psychiatric medication – a view which maps closely on to the aim that everyone should lead the best and most fulfilled life that they can.
Please read on for comments from Glenn Roberts, Adviser to Recovery Devon

Drugs and medication in psychiatric practice have seldom been without controversy and, along with compulsory admission to hospital, are the issues that most frequently sit in the middle of tensions and disagreements between practitioners and people who use services.

Prescribers are given considerable guidance and informational support about starting medications but there is little emphasis on stopping or customising the generalities of treatment protocols to individual preferences and experience in search of ‘what works best for me’. People who use medications are developing information about this and supporting one another in having healthier relationships with medication too.

This second edition of a guide to ‘Harm reduction in the use of psychiatric drugs and a guide to coming off’, is a major contribution from the perspective of experience based expertise.

The authors begin with a ‘Medical Disclaimer’ stating that, ‘This guide is written in the spirit of mutual aid and peer support. It is not intended as medical or professional advice. While everyone is different, psychiatric drugs are powerful and coming off suddenly or on your own can sometimes be dangerous.’

They also underline the value of a reasoned and reasonable approach rather than simply an opposing ‘anti-drug’ view, stating that, ‘ Pro-drug advocates focus on the risks of psychosis and extreme emotional states, while anti-drug advocates focus on the risks of taking drugs. But it is the belief of this guide, and the philosophy of our pro-treatment choice work at the Freedom Centre and the Icarus Project, that either-or thinking around drugs is a big part of the problem.’

They also touch on the commonly reported experience of people who use services and treatments that the core medical guidance on ‘partnership working’, ‘informed consent’ and ‘choice’ is too often lacking when it comes to the experience of day to day practice.

This guide offers a balanced and balancing perspective from a consumer viewpoint that suggests its readers use the guide, ‘not as the definitive resource but as a reference point to start your own research and learning. I think it also has fair claim to be a useful resource in the core education of all prescribers and teams involved in offering medication and supporting people in self management. At the very least it will appraise you of discussions going on and advice being exchanged in the peer community and could offer considerably more if we are to progress in partnership working.

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